Radiologist Focuses On Women's Breast Health

Hampton Roads Masters

November 30, 2009|By Prue Salasky, psalasky@dailypresss.com 247-4784

So much has changed since radiologist Melinda "Lindy" Dunn became the director of the Women's Imaging Pavilion at Sentara Williamsburg Regional Medical Center in 1998. Since then the technologies allowing for earlier and more accurate detection of breast cancers have improved dramatically, and the national mortality rate from breast cancer has dropped steadily - at the rate of 2.3 percent a year each year.

As the first female radiologist to practice on the Peninsula, Dunn broke the gender barrier. "A lot of people didn't value mammography, it was just something they had to do. It changed the whole bar for breast imaging for the whole area. The whole community embraced us. We felt welcomed and valued which led to a huge sense of responsibility," she says, crediting Donna Dettloff, team coordinator, and Rebecca Cary, mammography coordinator, with sharing her vision for quality care delivered with compassion.

This spring, the pavilion and its sister site, the Dorothy G. Hoefer Comprehensive Breast Center at Sentara Port Warwick in Newport News, were among the first in the nation to receive full accreditation from the National Accreditation Program for Breast Centers administered by the American College of Surgeons. The seal of approval involved a rigorous process assessing every aspect of the centers and their staff, which include the only fellowship-trained mammographers in the region.

Dunn started her medical career by earning nursing degrees from Virginia Commonwealth University and the University of Virginia before abandoning a doctoral program in health administration for medical school. Since her fourth year at the Medical College of Virginia in Richmond, when a radiology rotation inspired her to switch from her intended specialization in internal medicine, Dunn, 51, has devoted herself to the early detection and prevention of breast cancer in women. She completed her residency and fellowship in breast imaging at MCV. "It's my passion," she says.

(Her other passions are Bob, her husband of almost 30 years, her two poodles, Phoebe and Ezekiel, and tennis, all evident in the photos in her office.)

We met Dunn in her office and "reading room" to talk about the current state of mammography and the impact of the recent report by the U.S. Preventive Services Task Force. In it, the government-appointed panel of 16 health professionals recommended postponing mammogram screenings to age 50 for those without a family history and then reducing their frequency to every two years up until age 74.

DP: What do you think of the USPSTF report?

Dunn: I was just blown away. We have 40 years of accumulating data and long-term follow-up with population-based randomized trials that show that it [current screening practices that involve annual screening from age 40] does reduce mortality from breast cancer ... 2.3 percent per year since 1990. The biggest explanation is mammography though chemo has gotten better. Now 70 percent who are diagnosed are in stage zero or stage 1. They should expect a cure. With a delay we wouldn't be picking it up. There have been no new studies and yet the USPSTF issued drastic changes. This is not the way to go to conserve dollars for health care. It's a huge step backward. We'd see an increase in mortality. ... The two major risk factors are being a woman and getting older. Over 75, therefore, is a major factor. Most people don't have a family history. Only 20 percent of women diagnosed have a family history.

DP: Do you think it will change insurance guidelines?

Dunn: The members of the panel are not specialists. They're not managing breast cancer. These are family physicians and pediatricians. I don't think they're as influential. Insurers would have a hard time changing with the specialist groups - Society of Breast Imaging, American Cancer Society and the American College of Radiology - so loudly opposing it.

DP: Is there any validity to the USPSTF's argument about over-treatment?

Dunn: We have to be judicious about the tests we recommend. There's certainly anxiety over "false positives" but the women are so glad when they find out everything's fine. Most people don't want to wait six months. They don't complain. ... We try not to over-diagnose but the call-back rate went up a little after the changeover to digital.

DP: Is digital the major change in mammography you referenced?

Dunn: Digital changed everything. We changed over in January 2007. It's really expensive and a huge investment; there were trials and tribulations for all of us making the change but it was easier than I thought it was going to be. It's superior technology. When I have to read analog studies now I really hate it. With digital there are so many ways to manipulate the image. For women with dense breasts it's really better.